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The establishment of sulfate (SO42-) reduction during methanogenesis may considerably hinder the efficient energetic exploitation of methane, once removing sulfide from biogas is obligate and can be costly. In addition, sulfide generation can negatively impact the performance of methanogens by triggering substrate competition and sulfide inhibition. This study investigated the impacts of removing SO42- during fermentation on the performance of a second-stage methanogenic continuous reactor (R2), comparing the results with those obtained in a single-stage system (R1) fed with SO42--rich wastewater (SO42- of up to 400 mg L-1, COD/SO42- of 3.12-12.50). The organic load (OL) was progressively increased to 5.0 g COD d-1 in both reactors, showing completely discrepant performances. Sulfate-reducing bacteria outperformed methanogens in the consumption for organic matter during the start-up phase (OL = 2.5 g COD d-1) in R1, directing up to 73% of the electron flow to SO42- reduction. An efficient methanogenic activity was established in R1 only after decreasing the OL to 0.625 g COD d-1, after which methanogenesis prevailed by consuming ca. 90% of the removed COD. Nevertheless, high sulfide proportions (up to 3.1%) were measured in biogas. Conversely, methanogenesis was promptly established in R2, resulting in a methane-rich (> 80%) and sulfide-free biogas regardless of the operating condition. From an economic perspective, processing the biogas evolved from R2 would be cheaper, although the techno-economic impacts of managing the sulfur pollution in the fermentative reactor still need to be understood.
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Reatores Biológicos , Metano , Sulfetos , Metano/metabolismo , Águas Residuárias/química , Sulfatos/metabolismo , Separação de FasesRESUMO
ALPPS enables complete tumor resection in a shorter interval and a larger number of patients than classic two-stage hepatectomies. However, there is little evidence regarding long-term outcomes in patients with colorectal liver metastases (CLM). This study aims to evaluate the short and long-term outcomes of ALPPS in patients with CRM. Single-cohort, prospective, observational study. Patients with unresectable CLM due to insufficient liver remnant who underwent ALPPS between June 2011 and June 2021 were included. Of 32 patients treated, 21 were male (66%) and the median age was 56 years (range = 29-81). Both stages were completed in 30 patients (93.7%), with an R0 rate of 75% (24/32). Major morbidity was 37.5% and the mortality nil. Median overall survival (OS) and recurrence-free survival (RFS) were 28.1 and 8.8 months, respectively. The 1-3, and 5-year OS was 86%, 45%, and 21%, and RFS was 42%, 14%, and 14%, respectively. The only independent risk factor associated with poor RFS (5.7 vs 11.6 months; p = 0.038) and OS (15 vs 37 months; p = 0.009) was not receiving adjuvant chemotherapy. KRAS mutation was associated with worse OS from disease diagnosis (24.3 vs. 38.9 months; p = 0.025). ALPPS is associated with favorable oncological outcomes, comparable to traditional strategies to increase resectability in patients with CLM and high tumor burden. Our results suggest for the first time that adjuvant chemotherapy is independently associated with better short- and long-term outcomes after ALPPS. Selection of patients with KRAS mutations should be performed with caution, as this could affect oncological outcomes.
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Neoplasias Colorretais , Hepatectomia , Neoplasias Hepáticas , Humanos , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Neoplasias Colorretais/mortalidade , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/tratamento farmacológico , Pessoa de Meia-Idade , Hepatectomia/métodos , Masculino , Feminino , Idoso , Quimioterapia Adjuvante , Estudos Prospectivos , Adulto , Idoso de 80 Anos ou mais , Resultado do Tratamento , Veia Porta/cirurgia , Taxa de Sobrevida , Ligadura/métodos , Fatores de TempoRESUMO
Pedestrian detection based on deep learning methods have reached great success in the past few years with several possible real-world applications including autonomous driving, robotic navigation, and video surveillance. In this work, a new neural network two-stage pedestrian detector with a new custom classification head, adding the triplet loss function to the standard bounding box regression and classification losses, is presented. This aims to improve the domain generalization capabilities of existing pedestrian detectors, by explicitly maximizing inter-class distance and minimizing intra-class distance. Triplet loss is applied to the features generated by the region proposal network, aimed at clustering together pedestrian samples in the features space. We used Faster R-CNN and Cascade R-CNN with the HRNet backbone pre-trained on ImageNet, changing the standard classification head for Faster R-CNN, and changing one of the three heads for Cascade R-CNN. The best results were obtained using a progressive training pipeline, starting from a dataset that is further away from the target domain, and progressively fine-tuning on datasets closer to the target domain. We obtained state-of-the-art results, MR-2 of 9.9, 11.0, and 36.2 for the reasonable, small, and heavy subsets on the CityPersons benchmark with outstanding performance on the heavy subset, the most difficult one.
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We aimed to determine the herd and animal levels seroprevalence and associated factors for Toxoplasma gondii infections in cattle from the state of Paraíba, Northeastern Brazil. Herds (n = 434) and cows aged ≥ 24 months (n = 1,895) were randomly selected, and serum samples were tested with the immunofluorescence antibody test (IFAT) using as cutoff of 64. Of the 434 farms investigated, 197 had at least one seropositive cow (prevalence of 49.0%; 95% CI = 44.3%-53.8%), and the prevalence at animal level was 18.0% (95% CI = 5.3%-21.1%). The antibody titers ranged from 64 to 1024, with the most frequent titers being 64 (10.8%) and 128 (3.7%). The risk factors identified were property located in Sertão region (odds ratio [OR] = 3.07), property located in Agreste/Zona da Mata regions (OR = 2.00), animal purchasing (OR = 2.68), herd size of 34-111 animals (OR = 2.91) and herd size > 111 animals (OR = 6.97). The results suggest the wide distribution of T. gondii infections in cattle throughout the state of Paraíba, and the risk factors identified are not possible to correct.(AU)
Objetivou-se determinar a soroprevalência do rebanhos e de animais e os fatores associados à infecção por Toxoplasma gondii em bovinos do estado da Paraíba, Nordeste do Brasil. Rebanhos (n = 434) e vacas com idade ≥ 24 meses (n = 1.895) foram selecionados aleatoriamente, e as amostras de soro foram testadas com o teste de imunofluorescência (RIFI), usando-se como ponto de corte 64. Das 434 fazendas investigadas, 197 tiveram pelo menos uma vaca soropositiva (prevalência de 49%; IC 95% = 44,3%-53,8%), e a prevalência em nível de animais foi de 18% (IC 95% = 5,3%-21,1%). Os títulos de anticorpos variaram de 64 a 1024, sendo os títulos mais frequentes 64 (10,8%) e 128 (3,7%). Os fatores de risco identificados foram na propriedade localizada na região do Sertão ("odds ratio" [OR] = 3,07), na propriedade localizada na região do Agreste/Zona da Mata (OR = 2,00), na compra de animais (OR = 2,68), no tamanho do rebanho de 34-111 animais (OR = 2,91) e no tamanho do rebanho > 111 animais (OR = 6,97). Os resultados sugerem a ampla distribuição de infecções por T. gondii em bovinos em todo o estado da Paraíba, e os fatores de risco identificados não são passíveis de correção.(AU)
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Animais , Feminino , Bovinos/microbiologia , Toxoplasmose Animal/diagnóstico , Imunofluorescência/veterinária , Toxoplasma/patogenicidade , Brasil , Estudos SoroepidemiológicosRESUMO
The treatment of culture-negative periprosthetic joint infections (CN PJI) of the hip represents complex entities. We, as a result of this, report on 12 cases. Irrigation and debridement (I&D) with implant retention were performed in acute cases and two-stage revisions in chronic infections. Combined antibiotic therapy was administered in all cases for 12 weeks. Infection control was achieved in all patients with an infection-free rate of 100% at 7.5 years of average follow-up.
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Abstract Introduction The cleft palate is one of the most common congenital anomalies treated by plastic surgeons. The cleft width increases the tension of repair and necessitates excessive dissection that might affect maxillary growth. Decreasing the width of cleft minimize tension, dissection and may limit the impact on maxillary growth. Objectives The purpose of the study was to evaluate the effect of nasal layer closure of the hard palate at the time of cleft lip repair in patients with complete cleft lip and palate, to demonstrate the efficacy of narrowing the gap and to reduce the incidence of fistulae or other complications. Methods Thirty patients less than 1 year of age were included in this prospective observational study. A superiorly based vomer flap was used to repair the nasal layer of the cleft hard palate at the time of primary cleft lip repair. 12-14 weeks after the vomer flap, the cleft soft and hard palate was definitively repaired. Alveolar and palatal gaps were recorded during the 1st and 2nd operations to demonstrate the reduction of the gap defect. Results The mean reduction of the alveolar cleft width in patients who had a vomer flap in the first stage was 4.067 mm and the mean reduction of the palatal gap was 4.517 mm. Only 3 patients developed small fistula on the repaired nasal layer that was discovered and corrected during definitive palatoplasty. Conclusion Nasal layer closure is a simple surgical technique that can be used to close the hard palate at the time of cleft lip repair. It is a valuable addition to cleft lip and palate repair that may prevent some cleft palate surgical complications.
Resumo Introdução A fenda palatina é uma das anomalias congênitas mais comumente tratadas por cirurgiões plásticos. A largura da fenda aumenta a tensão do reparo e requer dissecção extensa que pode afetar o crescimento maxilar. Diminuir a largura da fenda minimiza a tensão, a dissecção e pode limitar o impacto no crescimento maxilar. Objetivos Avaliar o efeito do fechamento da camada nasal do palato duro no momento do reparo da fenda labial em pacientes com fenda labiopalatina completa, demonstrar a eficácia do estreitamento do gap (abertura) e reduzir a incidência de fístulas ou outras complicações. Método Trinta pacientes com menos de um ano foram incluídos neste estudo observacional prospectivo. Um retalho do vômer de base superior foi usado para reparar a camada nasal da fenda do palato duro no momento do reparo primário da fenda labial. Doze a 14 semanas após o retalho do vômer, a fenda no palato mole e duro foi submetida a reparo. Os gaps alveolares e palatais foram registradas durante a 1ª e a 2ª cirurgias para demonstrar a redução do defeito. Resultados A redução média da largura da fenda alveolar nos pacientes que apresentaram retalho do vômer no primeiro estágio foi de 4,067 mm e a redução média do gap palatino foi de 4,517 mm. Apenas três pacientes desenvolveram uma pequena fístula na camada nasal submetida a reparo, que foi identificada e corrigida durante a palatoplastia definitiva. Conclusão O fechamento da camada nasal é uma técnica cirúrgica simples que pode ser usada para fechar o palato duro no momento do reparo da fenda labial. É uma adição valiosa ao reparo de fenda labial e palatina que pode prevenir algumas complicações cirúrgicas da fenda palatina.
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INTRODUCTION: The cleft palate is one of the most common congenital anomalies treated by plastic surgeons. The cleft width increases the tension of repair and necessitates excessive dissection that might affect maxillary growth. Decreasing the width of cleft minimize tension, dissection and may limit the impact on maxillary growth. OBJECTIVES: The purpose of the study was to evaluate the effect of nasal layer closure of the hard palate at the time of cleft lip repair in patients with complete cleft lip and palate, to demonstrate the efficacy of narrowing the gap and to reduce the incidence of fistulae or other complications. METHODS: Thirty patients less than 1 year of age were included in this prospective observational study. A superiorly based vomer flap was used to repair the nasal layer of the cleft hard palate at the time of primary cleft lip repair. 12-14 weeks after the vomer flap, the cleft soft and hard palate was definitively repaired. Alveolar and palatal gaps were recorded during the 1st and 2nd operations to demonstrate the reduction of the gap defect. RESULTS: The mean reduction of the alveolar cleft width in patients who had a vomer flap in the first stage was 4.067mm and the mean reduction of the palatal gap was 4.517mm. Only 3 patients developed small fistula on the repaired nasal layer that was discovered and corrected during definitive palatoplasty. CONCLUSION: Nasal layer closure is a simple surgical technique that can be used to close the hard palate at the time of cleft lip repair. It is a valuable addition to cleft lip and palate repair that may prevent some cleft palate surgical complications.
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Fenda Labial , Fissura Palatina , Procedimentos de Cirurgia Plástica , Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Humanos , Lactente , Palato Duro/cirurgia , Retalhos Cirúrgicos , Vômer/cirurgiaRESUMO
BACKGROUND: Although 2-stage exchange arthroplasty is the preferred surgical treatment for periprosthetic joint infection (PJI) in the United States, little is known about the risk of complications between stages, mortality, and the economic burden of unsuccessful 2-stage procedures. METHODS: The 2015-2019 Medicare 100% inpatient sample was used to identify 2-stage PJI revisions in total hip and knee arthroplasty patients using procedural codes. We used the Fine and Gray sub-distribution adaptation of the conventional Kaplan-Meier method to estimate the probability of completing the second stage of the 2-stage PJI infection treatment, accounting for death as a competing risk. Hospital costs were estimated from the hospital charges using "cost-to-charge" ratios from Centers for Medicare and Medicaid Services. RESULTS: A total of 5094 total hip arthroplasty and 13,062 total knee arthroplasty patients had an index revision for PJI during the study period. In the first 12 months following the first-stage explantation, the likelihood of completing a second-stage PJI revision was 43.1% (95% confidence interval [CI] 41.7-44.5) for hips and 47.9% (95% CI 47.0-48.8) for knees. Following explantation, 1-year patient survival rates for hip and knee patients were 87.4% (95% CI 85.8-88.9) and 91.4% (95% CI 90.6-92.2), respectively. The median additional cost for hospitalizations between stages was $23,582 and $20,965 per patient for hips and knees, respectively. Hospital volume, Northeast or Midwest region, and younger age were associated with reduced PJI costs (P < .05). CONCLUSION: Although viewed as the most preferred, the 2-stage revision strategy for PJI had less than a 50% chance of successful completion within the first year, and was associated with high mortality rates and substantial costs for treatment failure.
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Artrite Infecciosa , Artroplastia de Quadril , Infecções Relacionadas à Prótese , Idoso , Artrite Infecciosa/cirurgia , Artroplastia de Quadril/efeitos adversos , Custos Hospitalares , Hospitais , Humanos , Medicare , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Estados Unidos/epidemiologiaRESUMO
The purpose of this research is to examine whether insurers have improved their economic performance through efficiency as a reaction to the prolonged period of low interest rates. The results of an analysis of 22 years of data, using a two-stage data envelopment analysis approach (DEA), show that there is an inverse relationship between efficiency and interest rate. The non-life insurance group had a superior level of efficiency compared with that of the life insurance group. It seems that life insurance companies, to some extent, transferred their inefficiency to customers to maintain their solvency. Additionally, this research shows that companies with substantial market power and bancassurance exceeded the performance of the rest of the industry.
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This study examined the determinants of financial literacy (FL) and its impact on access to financial services (AFS), using data collected from rural Ghana. A two-stage residual inclusion model is utilized to address the selection bias issue. The results showed that FL is affected by household heads' age, gender, education, asset ownership, homeownership, and economics education. The results revealed that FL is significant and positively related to AFS, but its square shows an inverse relation with saving mobilization. This indicated a non-linear relationship between FL and AFS. Moreover, we find that FL has a larger AFS impact for households with high-income and male household heads relative to their counterparts. The study recommended that the government can initiate the creation of a rural committee to educate rural residents on financial issues through radio broadcasting and meetings. Our findings highlighted the importance of FL on AFS in enhancing the welfare of rural households.
Este estudo examina os determinantes da educação financeira (FL) e seu impacto no acesso a serviços financeiros (AFS), usando dados coletados na zona rural de Gana. Um modelo de inclusão residual de dois estágios é utilizado para abordar a questão do viés de seleção. Os resultados mostram que a FL é afetada pela idade, sexo, educação, propriedade de ativos, propriedade e educação econômica dos chefes de família. Os resultados revelam que FL é significativo e positivamente relacionado ao AFS, mas seu quadrado mostra uma relação inversa com a mobilização de poupança. Isso indica uma relação não linear entre FL e AFS. Além disso, notou-se que o FL tem um impacto maior de AFS para famílias com alta renda e chefes de família do sexo masculino em relação às suas contrapartes. O estudo recomendou que o governo pode iniciar a criação de um comitê rural para educar os residentes rurais sobre questões financeiras por meio de radiodifusão e reuniões. Nossos resultados destacam a importância do FL no AFS para melhorar o bem-estar das famílias rurais.
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Apoio Financeiro , Economia Rural , EscolaridadeRESUMO
Governments have been challenged to provide timely medical care to face the COVID-19 pandemic. Under this pandemic, the demand for pharmaceutical products has changed significantly. Some of these products are in high demand, while, for others, their demand falls sharply. These changes in the random demand patterns are connected with changes in the skewness (asymmetry) and kurtosis of their data distribution. Such changes are critical to determining optimal lots and inventory costs. The lot-size model helps to make decisions based on probabilistic demand when calculating the optimal costs of supply using two-stage stochastic programming. The objective of this study is to evaluate how the skewness and kurtosis of the distribution of demand data, collected through sensors, affect the modeling of inventories of hospital pharmacy products helpful to treat COVID-19. The use of stochastic programming allows us to obtain results under demand uncertainty that are closer to reality. We carry out a simulation study to evaluate the performance of our methodology under different demand scenarios with diverse degrees of skewness and kurtosis. A case study in the field of hospital pharmacy with sensor-related COVID-19 data is also provided. An algorithm that permits us to use sensors when submitting requests for supplying pharmaceutical products in the hospital treatment of COVID-19 is designed. We show that the coefficients of skewness and kurtosis impact the total costs of inventory that involve order, purchase, holding, and shortage. We conclude that the asymmetry and kurtosis of the demand statistical distribution do not seem to affect the first-stage lot-size decisions. However, demand patterns with high positive skewness are related to significant increases in expected inventories on hand and shortage, increasing the costs of second-stage decisions. Thus, demand distributions that are highly asymmetrical to the right and leptokurtic favor high total costs in probabilistic lot-size systems.
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COVID-19 , Serviço de Farmácia Hospitalar , Humanos , Pandemias , SARS-CoV-2 , IncertezaRESUMO
The increase in biofuel production by 2030, driven by the targets set at the 21st United Nations Framework Convention on Climate Change (COP21), will promote an increase in ethanol production, and consequently more vinasse generation. Sugarcane vinasse, despite having a high polluting potential due to its high concentration of organic matter and nutrients, has the potential to produce value-added resources such as volatile fatty acids (VFA), biohydrogen (bioH2) and biomethane (bioCH4) from anaerobic digestion. The objective of this paper is to present a critical review on the vinasse treatment by anaerobic digestion focusing on the final products. Effects of operational parameters on production and recovery of these resources, such as pH, temperature, retention time and type of inoculum were addressed. Given the importance of treating sugarcane vinasse due to its complex composition and high volume generated in the ethanol production process, this is the first review that evaluates the production of VFAs, bioH2 and bioCH4 in the treatment of this organic residue. Also, the challenges of the simultaneous production of VFA, bioH2 and bioCH4 and resources recovery in the wastewater streams generated in flex-fuel plants, using sugarcane and corn as raw material in ethanol production, are presented. The installation of flex-fuel plants was briefly discussed, with the main impacts on the treatment process of these effluents either jointly or simultaneously, depending on the harvest season.
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Saccharum , Anaerobiose , Biocombustíveis , Reatores Biológicos , Etanol , Ácidos Graxos VoláteisRESUMO
La mitad de los pacientes con cáncer de origen colorrectal desarrollan metástasis hepáticas durante el curso de su enfermedad y de esas el 80% son irresecables. La resecabilidad se define no por la extensión de la hepatectomía, sino por la función del hígado remanente, por lo que para pacientes con ciertos factores favorables se pueden realizar técnicas de remodelación hepática para aumentar el volumen del hígado remanente para que este sea suficiente. La hepatectomía en dos tiempos se basa en procedimientos secuenciales que buscan tratar metástasis hepáticas colorrectales consideradas inicialmente irresecables, logrando la resección completa de las mismas dejando un remanente hepático funcionante suficiente, lo cual no sería posible en un solo acto quirúrgico. El objetivo de este trabajo es presentar el caso clínico de un paciente portador de metástasis hepáticas sincrónicas de origen colorrectal irresecables, que luego de una quimioterapia de conversión, con el fin de aumentar el futuro remanente hepático y evitar falla hepática postoperatoria y realizar una resección oncológica, fue sometido a una hepatectomía en dos tiempos, técnica utilizada con baja frecuencia en nuestro medio, destacando una evolución favorable, con marcadores tumorales en valores normales y sin evidencia imagenológica de recaída local ni sistémica.
Half of colorectal cancer patients develop liver metastases during the course of their disease, 80% of which are unresectable. Resectability is defined not by the extent of the hepatectomy, but by the function of the liver remnant. Therefore, for patients with certain factors, liver remodeling techniques can be performed to increase volume of the remaining liver so that it is sufficient. Two-stage hepatectomy is performed on colorectal liver metastases which are initially considered unresectable in one stage resection procedures, in which sequential procedures are performed in order to achieve complete resection and preserve a sufficient functioning liver remnant. The objective of this paper is to present the case of a patient with unresectable synchronous colorectal liver metastases, in which after conversion chemotherapy, in order to increase the future liver remnant, avoid postoperative liver failure and perform an oncological resection underwent a two-stage hepatectomy, a technique used with low frequency in our setting, highlighting a favorable evolution, with tumor markers in normal values and without imaging evidence of local or systemic relapse.
Metade dos pacientes com câncer colorretal desenvolve metástases hepáticas durante o curso da doença e, desses, 80% são irressecáveis. A ressecabilidade é definida não pela extensão da hepatectomia, mas pela função do fígado remanescente; portanto, para pacientes com certos fatores favoráveis, técnicas de remodelação hepática podem ser realizadas para aumentar o volume do fígado remanescente de forma que seja suficiente. A hepatectomia em dois estágios é baseada em procedimentos sequenciais que buscam tratar metástases hepáticas colorretais inicialmente consideradas irressecáveis, obtendo ressecção completa, deixando um remanescente hepático funcional suficiente, o que não seria possível em um único ato cirúrgico. O objetivo deste trabalho é apresentar o caso clínico de um paciente com metástases hepáticas sincrônicas irressecáveis de origem colorretal, que após quimioterapia de conversão, com o objetivo de aumentar o futuro remanescente hepático e evitar insuficiência hepática pós-operatória e realizar uma ressecção oncológica, foi submetido a dois Hepatectomia em estágio, técnica utilizada com baixa frequência em nosso meio, evidenciando evolução favorável, com marcadores tumorais em valores normais e sem evidências de imagem de recidiva local ou sistêmica.
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Humanos , Masculino , Idoso , Quimioterapia Adjuvante , Quimioterapia de Indução , Hepatectomia/métodos , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/tratamento farmacológico , Seguimentos , Resultado do Tratamento , Capecitabina/uso terapêutico , Bevacizumab/uso terapêutico , Oxaliplatina/uso terapêuticoRESUMO
This study aims to identify explanatory factors to increase the agricultural performance of Brazilian and Australian sugarcane mills. The relevance of Brazil and Australia for the sugar industry motivated the development this study based on the most important factors in both countries responsible for increasing the efficiency in sugarcane production. Thus, this study is designed to assess the hypothesis that there are a few explanatory variables that are deeply responsible for the agricultural efficiency in the sugar-energy sector. As a specific objective, it proposes a DEA (Data Envelopment Analysis) model that seeks to optimize the production of Total Recoverable Sugar (TRS) by planted area, and simultaneously, minimizes mineral and vegetable impurities. The sample consists of 82 observations from 32 sugarcane mills. An agricultural efficiency study was performed using the two-stage DEA, in which the evaluated mills according to the level of efficiency in the proposed model. Then, a Multiple Linear Regression Analysis was performed to identify the variables with the greatest influence on the performance of the mills in terms of efficiency. The results revealed six relevant variables for increasing the agricultural performance in the production of sugarcane: rainfall (mm weekly), chopped cane delivery (%), delivery time (h), borer (%), air humidity (%), and rods in raw wine (× 105/mL). Finally, semi-structured interviews with Brazilian and Australian experts in the sugar-energy sector allowed the identification of five other relevant complementary factors that were unavailable in the database: genetic variety, agricultural cultivation activities, edaphoclimatic factors, renewal of sugarcane fields and irrigation system. The results of this study were grouped into the dimensions of environment, yield, and impurities, providing quantification and better understanding of the identified explanatory factors and the agricultural performance in terms of production efficiency, offering fundamental information that enables managers to make decisions and prioritize the aspects that contribute more significantly to the increase in agricultural productivity of the planted area.
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BACKGROUND: The current preferred treatment for chronic hip and knee periprosthetic joint infection (PJI) involves both surgical intervention and antibiotic treatment as part of a two-stage revision. The purpose of this study is to determine how often patients who underwent a two-stage revision for chronic PJI developed a subsequent antibiotic-resistant infection. METHODS: We retrospectively reviewed the clinical records of 142 patients who underwent a two-stage revision for a chronic culture-positive PJI from January 2014 to May 2019. Demographic data and risk factors for PJI were identified. Resistance was defined in accordance with microbiology laboratory report and minimum inhibitory concentration. Statistical analysis consisted of descriptive statistics and univariate analysis. RESULTS: Only 10 of the 142 patients (7.04%) demonstrated emergence of resistance to antibiotics across their two-stage revision. At reimplantation, 25 (17.6%) patients had positive cultures. Of these, 16 patients presented with a novel organism and 9 patients had positive culture for the same organism as the initial infection. During the entire course of the two-stage revision, including spacer exchanges and irrigation and debridement procedures, 15 (10.56%) patients demonstrated persistent infections, whereas 25 (17.6%) patients presented with novel infections. 26 (18.3%) patients had reinfection of the same joint within one year. CONCLUSION: In the given cohort, there does not appear to be a major emergence of antibiotic resistant organisms in patients undergoing two-stage exchange arthroplasty and antibiotic treatment.
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Artroplastia de Quadril , Artroplastia do Joelho , Infecções Relacionadas à Prótese , Antibacterianos/uso terapêutico , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Resistência Microbiana a Medicamentos , Humanos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Resultado do TratamentoRESUMO
BACKGROUND: Large amounts of b-alanine are required in fine chemical and pharmaceutical synthesis and other fields. Profitable and green methods are required for the industrial production of b-alanine. RESULTS: Replacing endogenous panD of Escherichia coli with heterologous CgpanD from Corynebacterium glutamicum enabled b-alanine synthesis of 0.67 g/L by strain B0016-082BB. Overexpressing CgpanD on both plasmids and chromosomes to enhance the rate-limiting step improved the b-alanine titer to 4.25 g/L in strain B0016-083BB/pPL451-panD with a slighter metabolic burden. Growth factors were introduced by addition of yeast extract, and 6.65 g/L of b-alanine was synthesized by strain B0016- 083BB/pPL451-panD in the M9-3Y medium. CONCLUSIONS: Enhancement of the rate-limiting steps in the b-alanine biosynthetic pathway, recruitment of the temperature-sensitive inducible pL promoter, and optimization of the fermentation process could efficiently increase b-alanine production in E. coli.
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beta-Alanina/biossíntese , Temperatura , Escherichia coli , FermentaçãoRESUMO
RESUMEN Las resecciones hepáticas en dos tiempos se desarrollaron para aumentar la resecabilidad de los tumo res hepáticos en pacientes con futuro remanente hepático insuficiente. El ALPPS, descripto en 2011, ha representado un gran avance en el mundo de la cirugía hepatobiliopancreática. Esta técnica acelera la hipertrofia del futuro remanente hepático y reduce el intervalo de tiempo entre las dos cirugías en comparación con las técnicas clásicas. El ALPPS ha ganado popularidad rápidamente, con más de 1200 pacientes incluidos en el registro mundial. Los comités internacionales de expertos se han reunido en dos ocasiones con el fin de emitir recomendaciones, principalmente sobre las indicaciones, selección de pacientes y estandarización de la técnica quirúrgica. Aunque ha demostrado ser superior en términos de resecabilidad (entre el 80-100% frente al 60-90% de la hepatectomía en dos tiempos), su rápida implementación ha sido penalizada con alta morbi mortalidad en las series publicadas, que llega a alcanzar el 40% y el 9%, respectivamente. Además, la evidencia actual sobre los posibles beneficios y desventajas se basa mayoritariamente en estudios observacionales. Presentamos una revisión histórica, describiendo las diferentes modificaciones técnicas que se han lle vado a cabo desde su inicio y realizando una revisión rigurosa en términos de morbilidad, mortalidad y resultados oncológicos.
ABSTRACT Two-stage liver resections were described to increase the resectability of liver tumors in patients with insufficient future liver remnant. The ALPPS procedure, described in 2011, has represented a breakthrough in the field of hepato-pancreato-biliary surgery. This technique accelerates the hypertrophy of the future liver remnant and reduces the interval between the two surgeries compared with previous techniques. ALPPS has gained popularity rapidly, with more than 1200 patients included in the world registry. Recommendations about indications, patient selection and surgical standardization have been discussed twice in international expert meetings. Although ALPPS has proven to be superior in terms of resectability (80-100% versus 60-90% of two-stage hepatectomy), its rapid implementation has been punished with high morbidity and mortality reaching up to 40% and 9%, respectively, in the published series. The current evidence on the possible benefits and disadvantages is mainly based on observational studies. We present a historical review, describing the different technical modifications that have been carried out since its description, with a rigorous review in terms of morbidity, mortality, and oncological outcomes.
RESUMO
Green waste (GW) management is a key issue due to its high production rate and its variety of physical properties and chemical composition. Composting is a promising alternative for GW treatment and valorization. However, the presence of recalcitrant components such as lignin and cellulose increase the processing time. Strategies such as addition of co-substrates and operative modifications have improved the processing time and compost quality. Therefore, in this study, three strategies have been implemented (i) addition of unprocessed food (UF) and processed foods (PF) as co-substrates for GW to improve the nutrients composition of the substrates at the beginning of the process, (ii) addition of phosphate rock (PR) to improve product quality, and (iii) the use of two-stage composting (TSC) to accelerate the degradation. For this purpose, three treatments with the same mixture (48% GW + 21% UF + 18% PF + 13% sawdust (SW)) were conducted: (i) TA (TSC + 15% PR), (ii) TB (traditional composting +15% PR), and (iii) TC (traditional composting). TSC did not show significant differences compared with TC regarding the process and compost quality, while the addition of PR increased the phosphorus content of the product. However, TC produced the compost with the highest quality according to the Colombian legislation for soil amendment.
Assuntos
Compostagem , Eliminação de Resíduos , Colômbia , Países em Desenvolvimento , Alimentos , Nitrogênio/análise , SoloRESUMO
AIMS: We aimed to report the mid- to long-term rates of septic and aseptic failure after two-stage revision surgery for periprosthetic joint infection (PJI) following total hip arthroplasty (THA). METHODS: We retrospectively reviewed 96 cases which met the Musculoskeletal Infection Society criteria for PJI. The mean follow-up was 90 months (SD 32). Septic failure was assessed using a Delphi-based consensus definition. Any further surgery undertaken for aseptic mechanical causes was considered as aseptic failure. The cumulative incidence with competing risk analysis was used to predict the risk of septic failure. A regression model was used to evaluate factors associated with septic failure. The cumulative incidence of aseptic failure was also analyzed. RESULTS: There were 23 septic failures at final follow-up, with a cumulative incidence of 14% (95% confidence interval (CI) 8% to 22%) at one year, 18% (95% CI 11% to 27%) at two years, 22% (95% CI 14% to 31%) at five years, and 23% (95% CI 15% to 33%) at ten years. Having at least one positive culture (hazard ratio (HR) 2.38 (interquartile range (IQR) 1.19 to 4.74); p = 0.013), or a positive intraoperative frozen section (HR 2.55 (IQR 1.06 to 6.15); p = 0.037) was significantly associated with septic failure after reimplantation. With dislocation being the most common cause of aseptic revision (5.2%), the cumulative incidence of aseptic failure was 1% (95% CI 0% to 5%) at one year, 6% (95% CI 1% to 8%) at five years, and 8% (95%CI 3% to 17%) at ten years. CONCLUSION: If there is no recurrent infection in the five years following reimplantation, the chances of further infection thereafter are remote. While the results of a frozen section may be a reliable guide to the timing of reimplantation, intraoperative culture has, currently, only prognostic value. Surgeons should be aware that instability remains a potential indication for further revision surgery. Cite this article: Bone Joint J 2021;103-B(1):79-86.
Assuntos
Artroplastia de Quadril/métodos , Infecções Relacionadas à Prótese/classificação , Reoperação/métodos , Idoso , Biomarcadores/análise , Técnica Delphi , Feminino , Prótese de Quadril , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Infecções Relacionadas à Prótese/epidemiologia , Estudos Retrospectivos , Fatores de RiscoRESUMO
A two-stage bioreactor operated under anoxic denitrifying conditions was evaluated for desulfurization of synthetic biogas laden with H2S concentrations between 2500 and 10,000 ppmv. H2S removal efficiencies higher than 95% were achieved for H2S loads ranging from 16.2 to 51.9 gS mliquid-3h-1. Average H2S oxidation performance (fraction of S-SO42- produced per gram of S-H2S absorbed) ranged between 8.2 ± 1.2 and 18.7 ± 5.3% under continuous liquid operation. Nitrogen mass balance showed that only 2-6% of the N-NO3- consumed was directed to biomass growth and the rest was directed to denitrification. Significant changes in the bacterial community composition did not hinder the H2S removal efficiency. The bioreactor configuration proposed avoided clogging issues due to elemental sulfur accumulation as commonly occurs in packed bed bioreactors devoted to H2S-rich biogas desulfurization.